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Revenue Cycle Management Services
in Lafayette, LA
Qualigenix runs the revenue cycle for independent practices in Lafayette and across Lafayette Parish through Qualigenix revenue cycle management. One team handles eligibility, prior authorizations, coding, claims, payment posting, denials and A/R for every payer you bill.
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Speak with our RCM specialists today.
How Qualigenix Serves Lafayette Practices
Qualigenix gives each Lafayette practice one revenue cycle team, so the person who checks eligibility talks to the person who follows up on the claim. Statewide rules, from Louisiana Medicaid filing limits to prompt-pay timelines, are on our revenue cycle management services in Louisiana page. Lafayette practices lose revenue in the same five places we see nationally: eligibility and authorization errors at the front desk, coding and charge-capture gaps, denials nobody works, patient balances that sit, and contract underpayments. What's different in Lafayette Parish in 2026 and 2027 is how fast patient coverage is changing. Two Healthy Louisiana plans have left in one year, and new Medicaid renewal rules start in January. We set up eligibility, authorization and A/R work around those changes, inside the EHR you already use.
What RCM Services Does Qualigenix Provide in Lafayette?
Qualigenix covers eight connected services for Lafayette practices: insurance verification, prior authorizations, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing. We work every payer, including Healthy Louisiana plans, Medicare through Novitas Solutions, Medicare Advantage and commercial insurers.
You pay a percentage of collections, so our fee rises and falls with your collections.
RCM for Lafayette Parish's Healthy Louisiana Plans
Healthy Louisiana plans cover the whole state, so every plan serves Lafayette Parish. Today that's Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana Healthy Horizons in Louisiana and Louisiana Healthcare Connections. Healthy Blue's contract ends December 31, 2026, leaving four plans from January 1, 2027.
Eligibility Under 2027 Rules
From January 1, 2027, Louisiana Medicaid adults in the expansion group face new federal work requirements, and CMS guidance moves those adults to six-month renewals. Children, pregnant women and disability-based groups stay on annual renewals. For a Lafayette practice, that means more patients losing or changing coverage between visits. Qualigenix checks eligibility in eMEVS before every appointment, not once a year, and flags patients whose renewal is due so your front desk can remind them.
Authorizations Across Plan Changes
Since 2026, Medicare Advantage plans and Medicaid managed care plans must decide prior authorization requests within 72 hours for urgent requests and 7 calendar days for standard ones. Healthy Blue members moving to a new plan in January bring open authorizations with them. Louisiana Medicaid has said the receiving plan must honor services Healthy Blue already authorized for the first 60 days of 2027. We log every open authorization by patient and date, then submit new requests to the receiving plan before that period ends.
Statewide Louisiana RCM Rules
Medicaid filing windows, fee-for-service claims through Louisiana Medicaid and state prompt-pay rules apply in Lafayette as they do statewide. See how we handle them on our Louisiana revenue cycle rules page.
Medicare and Commercial Payers for Lafayette Practices
Novitas Solutions processes Medicare Part A and Part B claims for Louisiana under Jurisdiction H, and CMS awarded Novitas a new Jurisdiction H contract in June 2026. Qualigenix builds Lafayette Medicare claims to Novitas edits and works Medicare A/R through the Novitas portal. Lafayette Parish has about 21 dual-eligible special needs plans for 2026, from sponsors including Peoples Health, Humana, UnitedHealthcare, Aetna, Wellcare, Healthy Blue and Blue Cross and Blue Shield of Louisiana. For these patients we bill Medicare coverage first and the Healthy Louisiana plan second. On the payment side, Louisiana's updated prompt-pay rules start January 1, 2027. Commercial insurers will have 10 days for prior-authorized electronic clean claims, 25 days for other electronic clean claims and 30 days for most paper clean claims. Our A/R team follows up the day a clean claim passes its deadline.
PROVEN RCM PERFORMANCE
Results Lafayette Practices Can Expect
Qualigenix reports these numbers across all client practices. They're company-wide figures, not Lafayette-only results.
98%
Claim accuracy
4.8%
Denial rate
97.7%
Net collections rate
54 → 36
Days in A/R
38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$1.6B+
Total charges handled
$923M+
Accounts receivable recovered
1,400+
Providers set up nationally
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ Clinics6-DAY ONBOARDING
How Onboarding Works
Qualigenix takes over a Lafayette practice's revenue cycle in four steps, with go-live by day 6 on average.
01
Onboarding Call and Review
We review your billing setup, payer mix and denial trends, including which patients sit on Healthy Blue today.
02
Software and Portal Setup
We get access inside your existing EHR, clearinghouse and payer portals, including eMEVS and Novitas. Nothing changes for your staff.
03
Open Account Clean-Up
We sort open A/R by payer and age, fix enrollment gaps and line up 2027 plan changes before they hit claims.
04
Full Handover Day
New work moves to Qualigenix by day 6 on average, and older balances are worked in parallel.
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WHY LAFAYETTE PRACTICES CHOOSE QUALIGENIX
Why Lafayette Practices Choose Qualigenix
One team covering the full cycle, native operation inside any EHR across 133 platforms, transparent monthly reports by payer, and live onboarding by day six.
One Team, Full Cycle
The same team handles eligibility, authorizations, coding, claims and A/R. When something breaks, you call one place and get an answer.
Works Inside Any EHR
Qualigenix works in 133 EMR/EHR platforms. Your providers and front desk keep their system, and we work from inside it.
Monthly Reports by Payer
Each month you get collections, denials and A/R age broken out by payer, so you can see how each Healthy Louisiana plan is paying.
Live by Day Six
Most practices go live in an average of 6 days, with open A/R cleaned up and worked while new claims flow.
LAFAYETTE RCM FAQS
Frequently Asked Questions
Frequently asked questions regarding Healthy Louisiana plan transitions, prior authorizations, Medicaid expansion renewal rules, and RCM onboarding in Lafayette, LA.
Qualigenix RCM covers insurance verification, prior authorizations, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing. One team runs all eight for every payer you bill. Book a meeting to see which services your practice needs.
From January 1, 2027, Louisiana Medicaid expansion adults face work requirements and move to six-month renewals, and Healthy Blue members switch to one of four remaining plans. More patients will change or lose coverage between visits. Qualigenix checks eligibility before every appointment to catch it.
Yes. Qualigenix requests and tracks authorizations with every Healthy Louisiana plan, Medicare Advantage plans and commercial payers. Since 2026, Medicaid managed care and Medicare Advantage plans must decide standard requests within 7 calendar days and urgent ones within 72 hours.
Qualigenix cuts A/R days by catching eligibility and coding errors before submission, working denials quickly and following up on unpaid claims daily. Across client practices, days in A/R dropped from 54 to 36. Talk to a revenue cycle specialist to review your A/R.
No. A revenue cycle partner needs to know Louisiana's payers and rules, not sit in Lafayette. Qualigenix works inside your EHR and payer portals, including eMEVS and Novitas, for practices in 48 states. Book a meeting to see how it would run for you.
Qualigenix charges a percentage of collections, so the fee depends on what your practice collects. The exact percentage depends on your specialty, volume and which of the eight services you use. Book a meeting and we'll quote it from your numbers.
Qualigenix brings practices live by day 6 on average, in four steps: an onboarding call, software and portal setup, account clean-up and go-live. Existing A/R is worked in parallel so older balances keep moving during the switch.